Provider Demographics
NPI:1962157776
Name:STEWART, KALLIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:KALLIE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:KALLIE
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40465 MISTY OAK CT
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5455
Mailing Address - Country:US
Mailing Address - Phone:225-454-2325
Mailing Address - Fax:
Practice Address - Street 1:13025 HIGHWAY 44 STE 101-103
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6855
Practice Address - Country:US
Practice Address - Phone:225-726-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist